| NPI | 1376822742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR md166415) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R72865) |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2016-09-02 |