| NPI | 1437659596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10086896) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 36454) |
| 208000000X Pediatrics (Licence: PR 36454) | |
| Enumeration Date | 2018-02-15 |
| Last Update Date | 2024-05-14 |