| NPI | 1073928883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2022-028321) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301106233) |
| 208000000X Pediatrics (Licence: MI 4301106233) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301106233) | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2022-11-30 |