| NPI | 1821298738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2010-00425) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 2010-00425) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2012-07-31 |