| NPI | 1164914768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301503782) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301115372) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2021-01-31 |