| NPI | 1598077059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 23214) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL MD.31819) |
| 208000000X Pediatrics (Licence: MS 23214) | |
| 208000000X Pediatrics (Licence: AL MD.31819) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2022-05-02 |