| NPI | 1093198467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2019-0286) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301107894) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5315071136) | |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2020-04-20 |