| NPI | 1760860498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 51824) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA10439300) |
| 207R00000X Internal Medicine (Licence: NC 2018-02273) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2018-11-06 |