| 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 |