| NPI | 1629422423 |
|---|---|
| Former Name | PARIS ETHAN FITZGERALD |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101267142) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2022-04-08 |