| NPI | 1063152080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 14217639-1204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ID 1063152080) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2025-07-28 |