| NPI | 1194353169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WY 16949A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID M-17389) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2024-10-16 |