| NPI | 1104349372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA12029300) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 332562) |
| 207R00000X Internal Medicine (Licence: ME MD23369) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT214535) | |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2024-11-30 |