| NPI | 1700271988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R9471) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 294827) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: TX R9471) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2024-09-16 |