| NPI | 1487034245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2018-00945) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: NC 2018-00945) | |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2020-08-24 |