| NPI | 1629347752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME MD20530) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME114576) |
| 207R00000X Internal Medicine (Licence: TX Q2633) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-12-19 |
| Last Update Date | 2022-07-21 |