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 |