| NPI | 1659981751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301509341) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351045957) |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2024-08-15 |