| NPI | 1356751564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: MN 68845) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 68845) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2024-03-22 |