| NPI | 1386121218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01085438A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.072530) |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2022-10-14 |