| NPI | 1104083021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2010-00846) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 142044) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2010-05-24 |