| NPI | 1588868764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A99200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101245212) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207R00000X Internal Medicine (Licence: TX q6523) | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2016-12-30 |