| NPI | 1871908939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 64209) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 77662) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301104879) | |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2023-01-04 |