| NPI | 1235510140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101261224) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT208977) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2020-06-05 |