| NPI | 1164836185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 1351) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NE 1351) |
| 208D00000X General Practice (Licence: NE 1351) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2023-11-04 |