| NPI | 1053705764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 25712) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MS T-3198) |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2026-09-30 |