| NPI | 1265992820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2025-00839) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 92541) |
| 207R00000X Internal Medicine (Licence: NC 2015-00839) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-09-03 |