| NPI | 1295311082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX W5227) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 98940) |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2026-05-07 |