| NPI | 1780885145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME103138) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL ME103138) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN10080) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2009-07-09 |