| NPI | 1255719894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301505680) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036146030) |
| 207R00000X Internal Medicine (Licence: PA MD470855) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.025629) | |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2022-06-15 |