| NPI | 1710619895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A23770) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NV SL1892) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: SL1892) | |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2025-06-30 |