| NPI | 1215377932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN DO2935) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10045577) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2020-06-26 |