| NPI | 1922397918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61186052) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD206904) |
| 207R00000X Internal Medicine (Licence: MA 264420) | |
| 207R00000X Internal Medicine (Licence: NY 278134) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2025-10-30 |