| NPI | 1629464862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2018-0199) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 5738) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2024-09-11 |