| NPI | 1780002709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 40736) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 63511) |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2018-10-25 |