| NPI | 1063049732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102207620) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 11696) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2023-06-16 |