| NPI | 1568151199 |
|---|---|
| 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: TX BP10084793) |
| 207R00000X Internal Medicine (Licence: TX 207RG0100X) | |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2023-05-01 |