| NPI | 1598298614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME148897) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301112562) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5315085445) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301112562) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME148897) | |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2022-01-23 |