| NPI | 1639663255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: IN 02007120A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 32002) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2023-08-30 |