| NPI | 1932696119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 05-44665) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021029325) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2024-07-08 |