| NPI | 1538747035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 109516) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 13442) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10078282) | |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2026-07-09 |