| NPI | 1558057687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 125.081502) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.081502) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2024-08-30 |