| 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 |