| NPI | 1205129533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA09482100) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT199431) |
| 207R00000X Internal Medicine (Licence: CA C170716) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT199431) | |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2023-03-29 |