| NPI | 1104664713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA PTL16889) |
| Enumeration Date | 2024-07-17 |
| Last Update Date | 2026-03-25 |