| NPI | 1417698903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301513683) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 197267) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-06 |
| Last Update Date | 2025-08-07 |