| NPI | 1235833831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102210013) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 390200000X) |
| Enumeration Date | 2023-03-28 |
| Last Update Date | 2026-04-21 |