| NPI | 1669639282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101257884) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 25315) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2022-12-13 |