| NPI | 1639872864 |
|---|---|
| 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: WA 207R0000X) |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: OR MD22260) | |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2026-05-26 |