| NPI | 1003509381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 2024-03317) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: NC 2024-03317) | |
| Enumeration Date | 2023-06-01 |
| Last Update Date | 2026-05-17 |