| NPI | 1336604297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 7491920) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: WI 74919-20) | |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2023-08-14 |