| NPI | 1790312635 |
|---|---|
| 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: GA 90615) |
| 208D00000X General Practice (Licence: GA 90615) | |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2022-03-04 |