| NPI | 1194345645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351047064) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351047064) |
| Enumeration Date | 2020-04-24 |
| Last Update Date | 2021-02-09 |