| NPI | 1013371285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2025-0009) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101266391) |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2025-06-24 |