NPI | 1669096574 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MB11596200) |
Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MB11596200) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2020-06-05 |
Last Update Date | 2022-08-21 |