| NPI | 1588072540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: TX r4446) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX R4446) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.065012) | |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2024-07-30 |