| NPI | 1508273855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX V0133) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME146613) |
| 207R00000X Internal Medicine (Licence: MN 59546) | |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2024-05-28 |