| NPI | 1144970047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 338992) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VT 032.0134263) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2026-05-27 |