| NPI | 1922591197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 333249) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.073005) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 326524) | |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2023-02-27 |