| NPI | 1588168702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME MD29425) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX T0241) |
| 207R00000X Internal Medicine (Licence: DC MTL004748) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2025-08-01 |