| NPI | 1679585293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101252048) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208000000X Pediatrics (Licence: VA 0101252048) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2012-11-12 |