| NPI | 1619483245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME155089) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 308632) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-12-19 |
| Last Update Date | 2022-06-14 |