| NPI | 1851077374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 79161) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: SC MMD.90249LL) |
| Enumeration Date | 2023-06-27 |
| Last Update Date | 2026-07-23 |