| NPI | 1063869758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 284288) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 284288) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2021-09-09 |