| NPI | 1356872220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 304298) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NJ S13754336201904) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2020-06-23 |