| NPI | 1124717814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL MD.53265) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL 390200000X) |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2026-06-24 |