| NPI | 1740868512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO DR.0075969) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 329465) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2025-09-10 |