| NPI | 1245810829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2025-03326) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC RTL21-0365) |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2026-03-23 |