| NPI | 1972253557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 21912) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 2458) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2023-09-08 |