| NPI | 1720802523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 112326) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351054785) |
| 207R00000X Internal Medicine (Licence: NY P130909) | |
| Enumeration Date | 2024-11-09 |
| Last Update Date | 2026-06-27 |