| NPI | 1861848210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A182786) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 86607) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 1104271923) | |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2022-10-25 |