| NPI | 1548951387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI LP06155) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT228119) |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2024-06-22 |