| NPI | 1104250943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD15755) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA09955700) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2018-08-02 |