| NPI | 1679211726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101028807) |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2025-12-02 |