| NPI | 1407239718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A181829) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: KS 04-40944) | |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2024-02-15 |