| NPI | 1164386744 |
|---|---|
| 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: NY P140113) |
| Enumeration Date | 2025-12-09 |
| Last Update Date | 2026-06-19 |