| NPI | 1003602319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: MS T-5931) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS T-5931) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MS T-5931) | |
| Enumeration Date | 2025-04-15 |
| Last Update Date | 2026-07-09 |