| NPI | 1124508411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207RC0200X Internal Medicine Critical Care Medicine (Licence: AZ 71463) |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2024-07-12 |