| NPI | 1396128575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2021-02465) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL38363) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 239423) | |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2021-09-02 |