| NPI | 1558890483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.254743) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 323776) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2023-06-23 |