NPI | 1023497815 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 60588) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 297825) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2015-05-26 |
Last Update Date | 2019-06-20 |