| NPI | 1588185649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 74777) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 311084) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351028151) | |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2025-03-03 |