NPI | 1699352112 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC MMD92897MD) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 33786) |
207R00000X Internal Medicine (Licence: FL ME166800) | |
Enumeration Date | 2021-03-29 |
Last Update Date | 2025-10-04 |