| NPI | 1801834494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2010024108) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: FL ME 100924) | |
| 207R00000X Internal Medicine (Licence: IL 036136966) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2023-10-11 |