| NPI | 1356909626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 291230) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 280412) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2022-08-15 |