| NPI | 1790168409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD61376943) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 320937) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2023-04-14 |