| NPI | 1851910616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: TX V7927) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: MS T-4086) | |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2026-05-27 |