| NPI | 1558507665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C180272) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME EL141036) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT194705) | |
| Enumeration Date | 2008-12-18 |
| Last Update Date | 2023-01-05 |