| NPI | 1659809127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301516131) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101265645) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2026-05-13 |