| NPI | 1972083293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 90395) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 11700) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 15060-I) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2023-08-29 |