| NPI | 1609361948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01085386A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351038773) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2021-06-04 |