| NPI | 1811287972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q9681) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 59202) |
| 207R00000X Internal Medicine (Licence: CT 52315) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2019-09-23 |