| NPI | 1154588820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 66374) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 390200000X) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2018-04-04 |