| NPI | 1902114754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: WI 63774) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 63774-20) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2021-02-10 |