| NPI | 1104144419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME 124652) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 8153512-1205) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2016-09-01 |