| NPI | 1558818195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 0070208) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO 0008148) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2023-05-23 |