| NPI | 1326336900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101253877) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NJ P11-00062) |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2021-09-03 |