| NPI | 1821613837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR DO211735) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR PG198807) |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2023-06-22 |