| NPI | 1912439936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S8847) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS16198) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2024-06-26 |