| NPI | 1285992602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 38188) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME MD25645) |
| 207R00000X Internal Medicine (Licence: MA 283900) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2024-12-13 |