| NPI | 1902148802 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: MI 4301113116) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301113116) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-19 | 
| Last Update Date | 2023-11-27 |