| NPI | 1750519906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 277686) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 251036) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 241077) | |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2016-04-26 |