| NPI | 1669024584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10083094) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036159327) |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2023-04-28 |