| NPI | 1841462710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: LA MD 202251) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 262464) |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2015-10-28 |