| NPI | 1104064211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 43701) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY AC0552605) |
| Enumeration Date | 2009-01-27 |
| Last Update Date | 2025-03-24 |