| NPI | 1164916540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 65055) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 3387-320) |
| 207R00000X Internal Medicine (Licence: TX U6375) | |
| 207R00000X Internal Medicine (Licence: NY 325045) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2025-04-04 |