| NPI | 1578191458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2023-1219) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301509269) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2023-09-19 |