| NPI | 1255590287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VT 042.0013058) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AK 6880) |
| 207R00000X Internal Medicine (Licence: PA MD442728) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2015-04-09 |