| NPI | 1477793487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 253076) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D84140) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-03-03 |
| Last Update Date | 2020-11-04 |