| NPI | 1548614159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 10534782-1205) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2023-08-07 |