| NPI | 1790042802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX V0470) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 34528) |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2024-05-12 |