| NPI | 1407382070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 3045) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 4087) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2024-07-03 |