| NPI | 1891104527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2022-00212) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: VA 0101261593) | |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2022-05-25 |