| NPI | 1518444181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 70175) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2018-0776) |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2022-09-30 |