| NPI | 1811453582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 75070-21) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 75070-21) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2025-06-02 |