| NPI | 1851850127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME161593) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 290762) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 272189) | |
| Enumeration Date | 2019-03-17 |
| Last Update Date | 2023-05-23 |