| NPI | 1366896243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0087870) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX S0987) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2021-09-10 |