| NPI | 1053042366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101285256) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA MDRE.ML.61299254) |
| Enumeration Date | 2022-06-19 |
| Last Update Date | 2025-07-15 |