| NPI | 1619670296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.018077) |
| Enumeration Date | 2023-03-23 |
| Last Update Date | 2025-07-02 |