| NPI | 1285261545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-48067) |
| 207R00000X Internal Medicine (Licence: MO 2025010949) | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2026-03-05 |