| NPI | 1710255732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC DO36503) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58.004162) |
| Enumeration Date | 2011-12-05 |
| Last Update Date | 2022-08-04 |