| NPI | 1811440902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 22586) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 34191R) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 6021321) | |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2022-08-30 |