| NPI | 1376168534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NE 9335) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 11881) |
| Enumeration Date | 2020-06-13 |
| Last Update Date | 2022-06-16 |