| NPI | 1831415637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D85059) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301108174) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57-017502) | |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2022-07-21 |