| NPI | 1861883563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL TRN28047) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125070082) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-02-17 |
| Last Update Date | 2019-06-30 |