| NPI | 1912168279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P6363) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AL 29889) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2021-01-13 |