| NPI | 1811453582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 75070-21) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: WI 75070-21) | |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2022-07-24 |