| NPI | 1053810135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 30257) |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2023-12-21 |