| NPI | 1962996785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine Pulmonary Disease (Licence: IL 036.156516) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301114716) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2025-07-17 |