| NPI | 1518426576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NJ 25MA11784100) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 317421) |
| 207R00000X Internal Medicine (Licence: NJ 25MA11784100) | |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2023-06-12 |