| NPI | 1245717909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301507051) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.072953) |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2022-06-15 |