| NPI | 1154677391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 88509) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 63234-020) |
| 207R00000X Internal Medicine (Licence: MI 4301100667) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301100667) | |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2023-06-02 |