| NPI | 1891299756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 275576) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2021-06-02 |