| NPI | 1558716167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: TX V0812) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX V0812) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10056669) | |
| Enumeration Date | 2016-05-02 |
| Last Update Date | 2024-07-02 |