| NPI | 1679960751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 292386) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: NY 292386) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 731884637) | |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2023-01-09 |