| NPI | 1295264166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD210003040) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: VA 0101272332) | |
| 207R00000X Internal Medicine (Licence: MD D0092803) | |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2026-04-27 |