| NPI | 1710104799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME110003) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME110003) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: Medical Resident) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2023-10-31 |