| NPI | 1174873640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 301148) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 282N00000X General Acute Care Hospital (Licence: FL TRN18114) | |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2025-08-11 |