| NPI | 1255830378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 289185) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 289185) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 6112210) | |
| Enumeration Date | 2018-02-04 |
| Last Update Date | 2021-09-21 |