| NPI | 1972000248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 86571) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 313725) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2023-02-13 |