| NPI | 1265870299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 256886) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2014-06-23 |