| NPI | 1184115347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S9700) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME147744) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2024-06-05 |