| NPI | 1053972406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10066666) |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: NY NA) | |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2022-12-20 |