| NPI | 1427687078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151016918) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 58.031344) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2024-06-12 |