| NPI | 1750721197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 39277) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301103554) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301103554) | |
| Enumeration Date | 2013-06-30 |
| Last Update Date | 2023-08-15 |