| NPI | 1356808075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 22422) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME MD29102) |
| 207R00000X Internal Medicine (Licence: WI 8103-851) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-02-28 |
| Last Update Date | 2025-12-12 |