| NPI | 1679911275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 277599) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 55258) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2020-05-13 |