| NPI | 1558121285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MT MED-RES-LIC-142793) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MT MED-RES-LIC-142793) |
| Enumeration Date | 2024-03-20 |
| Last Update Date | 2026-09-01 |