| NPI | 1841684735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101273400) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME136025) |
| 207R00000X Internal Medicine (Licence: CA C198559) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2025-02-20 |