| NPI | 1215563671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME MD27611) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 59019) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2025-05-22 |