| NPI | 1154334399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY L 246-127) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY L 246-127) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207R00000X Internal Medicine (Licence: MI 4301093912) | |
| 208000000X Pediatrics (Licence: MI 4301093912) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2009-06-15 |