| NPI | 1811575533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 35.150251) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207RI0200X Internal Medicine, Infectious Disease (Licence: GA 112150) | |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2026-04-20 |