| NPI | 1902538960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: IL 036.173619) |
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: IL 036.173619) | |
| Enumeration Date | 2022-06-28 |
| Last Update Date | 2025-04-15 |