| NPI | 1912691643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WV 2203) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125082316) |
| Enumeration Date | 2023-06-06 |
| Last Update Date | 2025-09-10 |