| NPI | 1255516472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 293103-01) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD P19954) |
| 207R00000X Internal Medicine (Licence: FL ME109678) | |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2021-03-17 |