| NPI | 1487907184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: PR 18602) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 18602) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 18602) | |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2020-12-15 |