| NPI | 1942794458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101026132) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101024103) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101024103) | |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2021-06-28 |