| NPI | 1225772460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: TX U5812) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX U5812) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2026-04-19 |