| NPI | 1669848008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 20A18229) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MB10069600) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2021-04-27 |