| NPI | 1285204800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME167783) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA 61668317) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-26 |
| Last Update Date | 2025-05-30 |