| NPI | 1518524610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 82128) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10067733) |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: TX BP20081729) | |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2025-07-20 |