| NPI | 1578184172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10071527) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX T7729) |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2025-04-10 |