| NPI | 1548499270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME LT17006) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM A-1619-11) |
| 207R00000X Internal Medicine (Licence: VT 0128820) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2017-05-22 |