| NPI | 1255506416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 242503) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 242503) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2009-07-06 |