| NPI | 1134897077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 332062) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: IN 01096447A) | |
| Enumeration Date | 2021-09-04 |
| Last Update Date | 2025-06-17 |