| NPI | 1417305434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2022026880) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 0003650493) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2022-09-13 |