| NPI | 1629691506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 332302) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 284641) |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2025-02-25 |