| NPI | 1124768346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 336.128872) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 85410-20) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2025-06-08 |