| NPI | 1578229035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 336982) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO pending) |
| Enumeration Date | 2021-11-09 |
| Last Update Date | 2023-06-21 |