| NPI | 1306580550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD600003834) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101285296) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2025-08-02 |