| NPI | 1487174884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2022-0130) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10059580) |
| 207RA0000X Internal Medicine, Adolescent Medicine (Licence: NM MD2022-0130) | |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2024-03-13 |