| NPI | 1952711152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60770576) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR PG178688) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2018-03-17 |