| NPI | 1821452673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 139648) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK APMD32221) |
| 207R00000X Internal Medicine (Licence: OK MD32221) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2020-09-02 |