| NPI | 1639569882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A149797) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 290706) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-01-27 |
| Last Update Date | 2018-03-17 |