| NPI | 1740930692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116040223) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 327466-01) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2025-06-27 |