| NPI | 1609364827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 72462) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 72462) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2023-03-03 |