NPI | 1578134656 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2024-00989) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351047738) |
Enumeration Date | 2021-07-08 |
Last Update Date | 2024-05-06 |