| NPI | 1891107314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 87169) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MT 68251) |
| 207R00000X Internal Medicine (Licence: MT 87169) | |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2023-01-24 |