| NPI | 1528697117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 97609) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102209169) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2025-06-12 |