| NPI | 1619109634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: FL ME112732) |
| 207R00000X Internal Medicine (Licence: FL ME112732) | |
| Enumeration Date | 2009-08-10 |
| Last Update Date | 2021-06-29 |