| NPI | 1558723783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 76244) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 299289-1) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-26 |
| Last Update Date | 2024-06-25 |