| NPI | 1104485770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC None) |
| 207R00000X Internal Medicine (Licence: VA 0101281056) | |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2024-06-25 |