NPI | 1598393399 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: NY 324119) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2020-03-29 |
Last Update Date | 2023-06-27 |