| NPI | 1811560881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.173647) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.080277) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2025-03-20 |