| NPI | 1427340199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME120104) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: FL 10117) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2015-01-06 |