| NPI | 1629463443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301506586) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101264437) |
| 207R00000X Internal Medicine (Licence: MI 4351027624) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2023-01-20 |