| NPI | 1265060040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2025-01884) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX U1782) |
| 207R00000X Internal Medicine (Licence: AZ 73068) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2025-06-24 |