| NPI | 1649859786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2024-01074) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC SCHO-LNOOU5) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 304596) | |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2024-07-05 |