| NPI | 1932693538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV DO3202) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID O-1612) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2022-07-06 |