| NPI | 1912144403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 273307) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 52638-020) |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2022-07-21 |