| NPI | 1396324968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10086900) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.07776) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2024-07-01 |