| NPI | 1407035306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME113750) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125-050185) |
| 207R00000X Internal Medicine (Licence: CO 46890) | |
| Enumeration Date | 2007-10-26 |
| Last Update Date | 2016-11-14 |