| NPI | 1992047393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: UT 9149613-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO 59006) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-23 |
| Last Update Date | 2021-12-16 |