| NPI | 1104494707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301510786) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351047490) |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2024-07-01 |