| NPI | 1508181389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A128458) |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2021-06-08 |