| NPI | 1366736878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2014-01285) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 172804) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2025-08-05 |