| NPI | 1821518218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 28464) |
| 261QS1000X Clinic/Center, Student Health | |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2022-07-21 |