| NPI | 1033793161 |
|---|---|
| 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: MO 2021023174) |
| 207R00000X Internal Medicine (Licence: KS 94-10821) | |
| Enumeration Date | 2021-05-05 |
| Last Update Date | 2024-03-23 |