| NPI | 1942889803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME164504) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 59577) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2025-01-10 |