| NPI | 1255684221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME126304) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC MD38256) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 39) | |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2026-06-23 |