| NPI | 1134744055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD.MD.61479346) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: CA A187408) | |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2024-03-06 |