| NPI | 1861888992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 310801) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 66275) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AR 917774298) | |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2022-09-09 |