| NPI | 1548721715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 174400000X Specialist (Licence: NM 2024-0339) |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: NM 2024-0339) | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2024-05-16 |