| NPI | 1104175009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q3254) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 22635) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2021-11-26 |