| NPI | 1144964347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: NC 2026-02409) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: LA 345631) | |
| Enumeration Date | 2022-04-24 |
| Last Update Date | 2026-08-21 |