| NPI | 1427611581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2022-00350) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 251144) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2023-07-25 |