| NPI | 1225858715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NY 60-P130603-02) |
| Enumeration Date | 2024-10-10 |
| Last Update Date | 2025-03-25 |