| NPI | 1669903365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL0006415) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO TL.0006415) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2018-09-23 |