| NPI | 1033664891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.077757) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA S88343476) |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2021-05-25 |