| NPI | 1326537242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 289259) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 289259) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2022-11-01 |