| NPI | 1649712381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NC 2022-02723) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2016-11-11 |
| Last Update Date | 2023-09-07 |