| NPI | 1942462924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: FL ME128473) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 101249541) |
| 207R00000X Internal Medicine (Licence: TN MD49723) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2019-10-11 |