| NPI | 1790301034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 1014578) |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2024-06-20 |