| NPI | 1902483357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MI 4301510818) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301510818) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351047624) | |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2024-01-05 |