| NPI | 1972090868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 65806) |
| 207R00000X Internal Medicine (Licence: MN 29276) | |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2021-09-15 |