| NPI | 1871057828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101270352) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: VA 0101270352) | |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2024-12-16 |