NPI | 1801393798 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID CS65696) |
Additional Taxonomies | 208000000X Pediatrics (Licence: ID CS65696) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-04-09 |
Last Update Date | 2022-09-13 |