NPI | 1902235963 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME127535) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 312821) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2013-11-10 |
Last Update Date | 2021-10-04 |