| NPI | 1780263186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 12985064-1205) |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2025-08-04 |