| NPI | 1790241933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2023-1095) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 74929-20) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2024-01-15 |