| NPI | 1992331870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 72027) |
| 208000000X Pediatrics (Licence: MN 72027) | |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2023-04-18 |