| NPI | 1306286885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 35292) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 121244) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2025-07-15 |