| NPI | 1629622097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 70749) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 279969) |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2022-05-23 |