| NPI | 1912602640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 202602523) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL90194) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2026-07-08 |