| NPI | 1629425913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S6739) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2019-0011) |
| 207R00000X Internal Medicine (Licence: AZ R75708) | |
| 207R00000X Internal Medicine (Licence: AL MD.43026) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ R75708) | |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2021-09-13 |