| NPI | 1811124589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV DO2202) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 76516) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2024-05-06 |