| NPI | 1215480959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD215972) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT 71328) |
| 207R00000X Internal Medicine (Licence: ND RL14144) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: ND 14144) | |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2024-01-02 |