| NPI | 1104350800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S5645) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10058703) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2020-06-08 |