| NPI | 1760069819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 13640519-1204) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: ID O-1872) | |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2024-07-16 |