| NPI | 1780905711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 201300375) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 164554) |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2013-09-17 |