| NPI | 1871082784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 7189420) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 71894-20) |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2022-05-31 |