| NPI | 1144596578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 284078-01) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 68642) |
| 208000000X Pediatrics (Licence: NY 284078-01) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2021-08-23 |