| NPI | 1336760719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO 0011289) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 110860) |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2026-07-06 |