| NPI | 1770970105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2018-00509) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 209615) |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2019-04-16 |