| NPI | 1023679974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 321106) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MB11666200) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2024-09-11 |