| NPI | 1467795617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO CDR.0000672) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 52111) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2025-05-15 |