| NPI | 1093559494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0010917) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2024023426) |
| Enumeration Date | 2024-06-20 |
| Last Update Date | 2025-09-29 |