| NPI | 1093150773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME153738) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2017012768) |
| 207R00000X Internal Medicine (Licence: WV 26423) | |
| 207R00000X Internal Medicine (Licence: NM MD2017-0750) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2022-10-28 |