| NPI | 1114554250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1026432) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: NJ 25MA12277400) | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2026-06-29 |