| NPI | 1336758697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 35.153878) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP05032) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI LP05032) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2025-07-11 |