| NPI | 1982165528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX W5703) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102206440) |
| 208D00000X General Practice (Licence: VA 0102206440) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2026-06-09 |