| NPI | 1720281454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301083524) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60034280) |
| 208000000X Pediatrics (Licence: MI 4301083524) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301083524) | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2023-06-26 |