| NPI | 1255964003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS19956) |
| 208600000X Surgery (Licence: IL 125.077724) | |
| Enumeration Date | 2020-02-20 |
| Last Update Date | 2023-05-05 |