| NPI | 1801457742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME164598) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R77545) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NH R3980) | |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2023-09-28 |