| NPI | 1023768959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 14269322-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R80209) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2026-06-04 |