| NPI | 1982097408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 275483) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 25474657) |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2018-07-09 |