| NPI | 1932683562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 22860) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 15138) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-09-19 |
| Last Update Date | 2023-06-28 |