| NPI | 1629711916 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program | 
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: MI 5151015513) | 
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: MI 5151015513) | |
| Enumeration Date | 2022-04-15 | 
| Last Update Date | 2025-06-30 |