| NPI | 1023505534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A178503) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 38908) |
| 207R00000X Internal Medicine (Licence: GA 112436) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2026-06-10 |