| NPI | 1003493719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 25MA12264800) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 82949) |
| Enumeration Date | 2021-03-27 |
| Last Update Date | 2025-09-17 |