| NPI | 1790414159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 36563R) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 35818R) |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2024-01-30 |