| NPI | 1386919686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD.MD.60481954) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA ML 60285219) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2020-08-27 |