| NPI | 1215226303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: TX Q7161) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2011019430) |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2016-08-30 |