| NPI | 1841091980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID 1071460) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: KS 94-12575) | |
| Enumeration Date | 2025-03-24 |
| Last Update Date | 2026-07-01 |