| NPI | 1770151011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2024038740) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2021020989) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2024-10-10 |