| NPI | 1528742418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 341672) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND 19872) |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2024-06-10 |