| NPI | 1164832515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX BP10049392) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 582207) |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2016-07-28 |