| NPI | 1588848600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 36244) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0010927) |
| 207R00000X Internal Medicine (Licence: DE C1-0029807) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NJ P24-00328) | |
| Enumeration Date | 2007-12-26 |
| Last Update Date | 2026-06-23 |