| NPI | 1295197861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 325987) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A154636) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2021-05-03 |