| NPI | 1730563404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SD 15006) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 60584) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2024-02-28 |