| NPI | 1356727101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 161737) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 19789) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 13797-I) | |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2023-08-15 |