| NPI | 1760633457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ND 11281) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ND RL10211) |
| 207R00000X Internal Medicine (Licence: ND PT 11281) | |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2011-11-22 |