| NPI | 1831455856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.254090) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60454306) |
| 207R00000X Internal Medicine (Licence: IL 036155204) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI LP05709) | |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2023-05-31 |