| NPI | 1487090700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 18609) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 55221) |
| 207R00000X Internal Medicine (Licence: AZ 63809) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2023-05-18 |