| NPI | 1013100973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX P0167) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND 15462) |
| 207R00000X Internal Medicine (Licence: TX P0167) | |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2024-03-15 |