| NPI | 1386175263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 327430) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207R00000X Internal Medicine (Licence: CA A157040) | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2021-10-20 |