| NPI | 1477118057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102209147) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 05560) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2026-03-09 |