| NPI | 1871059352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 101397) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 0000062785) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-02-20 |
| Last Update Date | 2024-09-24 |