| NPI | 1669275483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58.034692) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 58.034692) |
| Enumeration Date | 2025-03-28 |
| Last Update Date | 2025-06-19 |