| NPI | 1598516320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN41774) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY P125485) |
| Enumeration Date | 2024-03-29 |
| Last Update Date | 2025-04-24 |