| NPI | 1508166984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5151012042) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: MI 5151012042) |
| 242T00000X Perfusionist | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-11-01 |
| Last Update Date | 2021-07-05 |