| NPI | 1073175816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 1073175816) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2024-07-20 |