| NPI | 1124644869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC LL84599) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL84599) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX V1238) | |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2024-05-14 |