| NPI | 1225770530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ R79438) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2026-0009) |
| Enumeration Date | 2022-04-08 |
| Last Update Date | 2026-06-18 |