| NPI | 1104292978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 63299) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2023-04-21 |