| NPI | 1194178004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK 35144) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT211898) |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: OK 35144) | |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2022-12-01 |