| NPI | 1255020947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL TRN42149) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: WI 23338) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN42149) | |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2025-05-13 |