| NPI | 1740860121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58.032119) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 22338) |
| 207R00000X Internal Medicine (Licence: OH 58.032119) | |
| Enumeration Date | 2021-04-10 |
| Last Update Date | 2024-01-14 |