| NPI | 1205215415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 19315) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: MO 2023039360) | |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2023-12-29 |