| NPI | 1134408123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME156671) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 58442) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2022-10-24 |