| NPI | 1639597693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SD 10480) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 61641) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-06 |
| Last Update Date | 2020-07-22 |