| NPI | 1023354800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NY 273462) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ZZ 60811) |
| Enumeration Date | 2012-12-22 |
| Last Update Date | 2014-07-07 |