| NPI | 1700955192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 42441) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ 76967) |
| 207R00000X Internal Medicine (Licence: TX Q1510) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2023-03-07 |