| NPI | 1598385965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 90356) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 261256) |
| Enumeration Date | 2020-04-25 |
| Last Update Date | 2024-09-24 |