| NPI | 1699234401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS19648) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL U06506) | |
| 208D00000X General Practice (Licence: FL OS19648) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2023-07-11 |