| NPI | 1790485647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: TN 6434) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 6434) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2025-08-06 |