| NPI | 1184155848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S6482) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: TX BP10059636) | |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2020-10-05 |