| NPI | 1811489891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT018282) |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: IA DO-05778) | |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2025-06-25 |