| NPI | 1982068094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 291746) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 291746) |
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: MA 291746) | |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2023-04-18 |