| NPI | 1669635785 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: NV 16309)  | 
| Additional Taxonomies | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: MS 21747)  | 
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: LA 309848)  | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116019889)  | |
| Enumeration Date | 2008-07-09 | 
| Last Update Date | 2019-07-23 |