| NPI | 1164162335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 337536) |
| 207R00000X Internal Medicine (Licence: NJ 25MA12742100) | |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2025-06-26 |