| NPI | 1174818181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q8776) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301098890) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301098890) | |
| Enumeration Date | 2011-06-17 |
| Last Update Date | 2018-01-05 |