| NPI | 1972181519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 56876) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL UO8151) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2025-06-27 |