| NPI | 1407172323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 266510-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 51215) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-16 |
| Last Update Date | 2016-03-01 |