| NPI | 1306584669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207RI0200X Internal Medicine, Infectious Disease (Licence: IL 125.085123) |
| Enumeration Date | 2022-05-25 |
| Last Update Date | 2025-12-30 |