| NPI | 1548813587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME153988) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN29743) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN29743) | |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2022-06-22 |