| NPI | 1780115964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA MD-48442) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT MED-RES-LIC-58298) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2021-04-08 |