| NPI | 1821607136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2020016508) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 20200165508) |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2024-01-05 |