| NPI | 1861987232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207RC0200X Internal Medicine Critical Care Medicine (Licence: SC 91506) |
| 207RP1001X Internal Medicine Pulmonary Disease (Licence: SC 91506) | |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2024-06-06 |