| NPI | 1548326929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116018938) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT184969) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2008-01-22 |