| NPI | 1447889050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT MED-RES-LIC-113337) |
| 207R00000X Internal Medicine (Licence: IN 02008428A) | |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2025-08-01 |