| NPI | 1568924744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101027388) |
| 208D00000X General Practice (Licence: MI 5101027388) | |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2023-05-18 |