| NPI | 1881004802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME153895) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 1154345510) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2022-02-17 |