| NPI | 1376983205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301116899) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301116899) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2023-11-27 |