| NPI | 1306121314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 307799) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 55796) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-10-21 |
| Last Update Date | 2022-01-24 |