| NPI | 1598119216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.152557) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 304237) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2021-11-22 |