| NPI | 1588077234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01088490A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD183681) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2022-09-01 |