| NPI | 1932350741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N8087) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO tl2222) |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2013-09-19 |