| NPI | 1750943643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-46397) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2019018926) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2022-08-01 |