| NPI | 1710212758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301094285) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301094285) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: 4301094285) | |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2015-08-05 |