| NPI | 1578149027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN33930) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME164567) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2023-11-07 |