| NPI | 1396438560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 3015117) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 3015117) |
| Enumeration Date | 2023-06-01 |
| Last Update Date | 2023-06-01 |