| NPI | 1649769993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 63503) |
| 207R00000X Internal Medicine (Licence: TX U5366) | |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2023-07-11 |