| NPI | 1114472966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 3017948) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A192578) |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2025-05-12 |