| NPI | 1649705351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 73655) |
| 207R00000X Internal Medicine (Licence: ME DO2942) | |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2024-04-03 |