| NPI | 1508350919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2021-00404) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 202100404) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301114663) | |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2024-04-22 |