| NPI | 1619405180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 85711) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 271836) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2021-08-23 |