| NPI | 1891305819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MO 2020013962) |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2021-06-24 |