| NPI | 1619157245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 62325) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 062325) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-11-12 |
| Last Update Date | 2020-01-24 |