| NPI | 1285924563 |
|---|---|
| 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: NC 2014-00542) |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2015-02-09 |