NPI | 1699187955 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301105388) |
Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301105388) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301105388) | |
Enumeration Date | 2014-05-21 |
Last Update Date | 2018-06-12 |