| NPI | 1417483066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A185775) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: UT 11761991-1205) | |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2023-07-25 |