| NPI | 1861626574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2012021730) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: WI 55456-20) | |
| Enumeration Date | 2009-05-08 |
| Last Update Date | 2016-05-29 |