| NPI | 1376047258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA OP61520656) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT MED-RES-LIC-67469) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2024-04-26 |