| NPI | 1023699204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101028130) |
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology (Licence: OH 34.018539) |
| Enumeration Date | 2021-04-19 |
| Last Update Date | 2026-06-15 |