| NPI | 1588963805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301104334) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI H240758609351) |
| Enumeration Date | 2011-03-25 |
| Last Update Date | 2016-02-01 |