| NPI | 1346582160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.062640) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11017999A) | |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2016-02-02 |