| NPI | 1235534215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 130827) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 100021299) |
| Enumeration Date | 2014-11-03 |
| Last Update Date | 2017-07-19 |