| NPI | 1871177386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 51801) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 99948) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2025-07-28 |