| NPI | 1063972636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 35.144376) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.144376) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2023-07-30 |