| NPI | 1982213948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.077285) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI FR4639829605) |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2021-06-16 |