| NPI | 1528488798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61493634) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 269504) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 259135) | |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2024-04-11 |