| NPI | 1659987683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1014074) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125075474) |
| Enumeration Date | 2020-09-15 |
| Last Update Date | 2023-05-11 |