| NPI | 1831576487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 60824366) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 61373) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2018-08-20 |