| NPI | 1679064034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10099272) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.145198) |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2026-06-02 |