| NPI | 1467839266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 61718) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 061718) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2018-08-11 |