| NPI | 1538722343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 35152) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 070795) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2025-06-19 |