| NPI | 1689977985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 738770) |
| Enumeration Date | 2010-12-09 |
| Last Update Date | 2012-06-28 |