| NPI | 1104314889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME167365) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 30599) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2024-06-27 |