| NPI | 1356839799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 315426) |
| 208000000X Pediatrics (Licence: NY 315426) | |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2022-06-28 |