| NPI | 1588302434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2026-0648) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX V9166) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10081515) | |
| Enumeration Date | 2022-05-20 |
| Last Update Date | 2026-07-30 |