| NPI | 1902346943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX U2336) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0088664) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-02-23 |
| Last Update Date | 2023-07-28 |