| NPI | 1598345647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 72531) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 72531) |
| 208000000X Pediatrics (Licence: AZ 72531) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2024-03-18 |