| NPI | 1750764379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 57043) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: DC MTL002867) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2019-01-16 |