| NPI | 1376808048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT AB350126936) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT AB350126936) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2013-11-01 |