| NPI | 1477087450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 78749) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC MD049327) |
| 208000000X Pediatrics (Licence: DC MD049327) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2026-05-18 |