| NPI | 1265870281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 268708) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 256014) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2022-10-05 |