| NPI | 1427739028 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 78613) | 
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: FL 38675) | 
| Enumeration Date | 2023-07-26 | 
| Last Update Date | 2025-06-12 |