| NPI | 1346745312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS17537) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL OU6008) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2021-06-08 |