| NPI | 1801415963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC RTL24-0113) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS022832) |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2024-09-16 |