| NPI | 1740844208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10078200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.074412) |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2024-03-05 |