| NPI | 1417526997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 318397) |
| 208D00000X General Practice (Licence: NY 318397) | |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2022-11-15 |