| NPI | 1760703623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A20663) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 006199) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R1508) | |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2024-06-05 |