| NPI | 1396095790 |
|---|---|
| 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 298621) |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2019-05-02 |