| NPI | 1750635801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: HI MD-20897) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 052542) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207R00000X Internal Medicine (Licence: GU M-1868) | |
| Enumeration Date | 2012-10-27 |
| Last Update Date | 2025-01-22 |