| NPI | 1174039226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS16405) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL UO5513) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO5513) | |
| Enumeration Date | 2017-12-26 |
| Last Update Date | 2022-11-27 |