| NPI | 1922538834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 75501) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 68572) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2024-10-28 |