| NPI | 1578907424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 0057160) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 315725) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2023-07-17 |