| NPI | 1942363197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A10492) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 10A 10492) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2023-05-08 |