| NPI | 1518632306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01092820A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125078150) |
| Enumeration Date | 2021-08-12 |
| Last Update Date | 2024-04-04 |