| NPI | 1861117541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 36502) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 36502) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-10-05 |
| Last Update Date | 2022-10-06 |