| NPI | 1720508963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT MED-PHYS-LIC-92087) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 92087) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2023-06-30 |