| NPI | 1528267382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036139636) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.009648) |
| 207R00000X Internal Medicine (Licence: MN 60348) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2018-04-24 |