NPI | 1124693544 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA12275300) |
Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MA12275300) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2021-05-26 |
Last Update Date | 2024-07-11 |