| NPI | 1033763321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL88262) |
| 208000000X Pediatrics (Licence: SC LL88262) | |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2022-06-21 |