| NPI | 1275220550 |
|---|---|
| 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: AZ 4351051622) |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2026-05-15 |