| NPI | 1790344919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.076008) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL TRN28890) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2020-06-28 |