| NPI | 1689052581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 313658-01) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX R4525) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2023-04-12 |