| NPI | 1942884820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX V1122) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: BP10075228) |
| Enumeration Date | 2021-05-07 |
| Last Update Date | 2025-04-10 |