| NPI | 1649560491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A12757) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WV AB8675398-033) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2021-12-06 |