| NPI | 1417709254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR PG226825) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR PG219855) |
| Enumeration Date | 2024-04-04 |
| Last Update Date | 2025-08-25 |