| NPI | 1255535779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01066616A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301088348) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301088348) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2009-12-17 |