| NPI | 1336639426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 287092) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.072375) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: 125-072375) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2021-09-08 |