| NPI | 1265029854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR PG226548) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR PG215608) |
| Enumeration Date | 2020-12-29 |
| Last Update Date | 2025-07-23 |