| NPI | 1316512197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA R-13318) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0008964) |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2024-08-26 |