| NPI | 1427051739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 85852) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101253496) |
| 363AM0700X Physician Assistant, Medical (Licence: MD C0002545) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2022-10-18 |