| NPI | 1558851139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301504366) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301504366) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301115151) | |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2023-09-15 |