| NPI | 1497117550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VT 042-0014457) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VT GNF933) |
| Enumeration Date | 2016-03-27 |
| Last Update Date | 2019-07-26 |