| NPI | 1184118812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A195959) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 311288) |
| 207R00000X Internal Medicine (Licence: PA MD474426) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-16 |
| Last Update Date | 2024-07-01 |