| NPI | 1083266837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 291898) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 29713) |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2024-04-14 |