| NPI | 1811156680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME104240) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY ac0552605053) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2015-11-18 |