| NPI | 1235528902 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: MD D86045) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0086045) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-01-17 | 
| Last Update Date | 2021-02-16 |