| NPI | 1861997926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2020005828) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MO 2020005828) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2025-10-27 |