| NPI | 1265843544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301105278) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301105278) |
| 208000000X Pediatrics (Licence: MI 4301105278) | |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2014-05-08 |