| NPI | 1619405057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: WI 81213) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2025-07-21 |