| NPI | 1144585043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q1617) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME156465) |
| 207R00000X Internal Medicine (Licence: LA 331776) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT201440) | |
| Enumeration Date | 2012-07-07 |
| Last Update Date | 2023-08-09 |