| NPI | 1710441456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1020769) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 193896) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-01-28 |
| Last Update Date | 2024-08-01 |