| NPI | 1740740422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL MD.44914) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 10901) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2022-08-29 |