| NPI | 1790076164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 1790076164) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 57767) |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2020-11-10 |