| NPI | 1770738593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 262413) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2010038106) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-11-20 |
| Last Update Date | 2015-06-09 |