NPI | 1366898777 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: NY 297594) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NY 297594) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-05-04 |
Last Update Date | 2025-08-04 |