| NPI | 1093374894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ R81692) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 87594) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2025-06-05 |