| NPI | 1982454955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY IP1943) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.084106) |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2025-07-17 |