| NPI | 1528828282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NV LL4184) |
| Enumeration Date | 2024-03-20 |
| Last Update Date | 2024-07-08 |