| NPI | 1265172159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME171269) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A200481) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2025-08-04 |