| NPI | 1871084764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NH 21313) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 275765) |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2021-06-24 |