| NPI | 1710507652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2024-02402) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NC 2024-02402) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2024-09-20 |