| NPI | 1851742092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2019024531) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10057726) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2019-08-27 |