| NPI | 1346879822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61416869) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR PG205868) |
| 207R00000X Internal Medicine (Licence: OR 209524) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2023-06-12 |