| NPI | 1114565041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 336477) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036164991) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-12-10 |
| Last Update Date | 2023-09-29 |