| NPI | 1023751187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN35035) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME174364) |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2025-11-05 |