| NPI | 1356873012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5315213109) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5315213109) |
| 207R00000X Internal Medicine (Licence: NY 305489) | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2021-06-02 |