| NPI | 1194474577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 88279) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: FL 178613) | |
| 207R00000X Internal Medicine (Licence: SC 1111111111) | |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2026-07-10 |