| NPI | 1619665478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX W7368) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10085240) |
| Enumeration Date | 2023-04-28 |
| Last Update Date | 2026-07-02 |