| NPI | 1942876925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: UT 13700479-1204) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR PG204624) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR PG204624) | |
| Enumeration Date | 2021-06-01 |
| Last Update Date | 2024-03-06 |