| NPI | 1972852390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SD 9554) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116024419) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2018-08-06 |