| NPI | 1669165940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101029311) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151016265) |
| Enumeration Date | 2023-06-01 |
| Last Update Date | 2026-09-10 |