| NPI | 1477717445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2010-00095) |
| Additional Taxonomies | 207RG0300X Internal Medicine Geriatric Medicine (Licence: NC 2010-00095) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2023-12-27 |