| NPI | 1366736845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 52287) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: TN 52287) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2019-07-08 |