| NPI | 1235781972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB11439500) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 39020000x) |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2026-05-29 |