| NPI | 1245890375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 321871) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301507074) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351044758) | |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2024-05-08 |