| NPI | 1265012546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A194556) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA A194556) |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2026-05-22 |