| NPI | 1992383608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 1265971691) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX 1265971691.) |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2021-05-17 |