| NPI | 1407238900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 58887) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 31,659-R) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2019-04-19 |