| NPI | 1174029417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116038898) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 69051) |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2024-06-14 |