| NPI | 1447646435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 313052) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: LA 313052) | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2019-08-23 |