| NPI | 1912563875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01088011A) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10061779) |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2023-03-13 |