| NPI | 1174986293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TN 0000059602) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 0000059602) |
| 207R00000X Internal Medicine (Licence: OR MD214746) | |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2025-05-14 |