| NPI | 1902337835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 02005998A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125069970) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2020-07-09 |