| NPI | 1407484694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.249004) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2025-02-03 |