| NPI | 1922646173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 91403) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 89690) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 11843) | |
| Enumeration Date | 2019-12-18 |
| Last Update Date | 2023-06-02 |