| NPI | 1821229279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: ID M-11976) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 240133) |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2025-12-22 |