| NPI | 1619435559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 318406-01) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 318406) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-11 |
| Last Update Date | 2024-07-25 |