| NPI | 1922412972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 19510) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 31159-R) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2017-07-20 |