| NPI | 1295970101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2022-0995) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 0129951) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-12-05 |
| Last Update Date | 2022-07-29 |