| NPI | 1730838863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301513417) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301513417) |
| 207R00000X Internal Medicine (Licence: NY 338648) | |
| 207R00000X Internal Medicine (Licence: TX V3420) | |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2026-02-10 |