| NPI | 1679928584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA10526000) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 244202) |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2019-09-25 |