| NPI | 1174020986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP61094156) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 71931) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 71722-20) | |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2024-03-12 |