| NPI | 1194474577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 88279) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 1111111111) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2025-06-04 |