| NPI | 1629418280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM DO2024-0083) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM DO2024-0083) |
| 207R00000X Internal Medicine (Licence: MA 256825) | |
| 207R00000X Internal Medicine (Licence: ID O-1045) | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2024-06-24 |