| NPI | 1629505094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME146483) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: OH 35.139971) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2022-02-02 |