| NPI | 1922499508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 81527) |
| Additional Taxonomies | 2086S0129X (Licence: SC 81527) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-02-18 |
| Last Update Date | 2025-11-03 |