| NPI | 1922633163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351053795) |
| 207R00000X Internal Medicine (Licence: TX BP10081140) | |
| Enumeration Date | 2020-03-09 |
| Last Update Date | 2025-08-08 |