| NPI | 1982068045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME163433) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 37206) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.246879) | |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2023-07-11 |