| NPI | 1720778046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10084833) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10084833) |
| Enumeration Date | 2023-05-10 |
| Last Update Date | 2023-05-15 |