| NPI | 1952988958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208D00000X General Practice (Licence: NM MD2023-1209) |
| 207R00000X Internal Medicine (Licence: NM MD2023-1209) | |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2023-11-01 |