| NPI | 1518717487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 76638) |
| 207R00000X Internal Medicine (Licence: TN 76638) | |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2026-07-14 |