| NPI | 1013309566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA10111800) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-02-20 |
| Last Update Date | 2022-07-21 |