| NPI | 1124720883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: MO 2026013445) |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2026-07-01 |