| NPI | 1558915306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 35.144532) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125073918) |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2022-07-12 |