| NPI | 1235691072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA MD-49870) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 7530320) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2024-03-13 |