NPI | 1932633500 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125070650) |
Additional Taxonomies | 208000000X Pediatrics (Licence: IL 125070650) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-04-20 |
Last Update Date | 2017-08-13 |