| NPI | 1568920882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OR DO212889) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116035953) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2022-08-31 |