| NPI | 1891043386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 49984) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R73430) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2019-04-08 |