| NPI | 1699147371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 345819-01) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 345819-01) |
| Enumeration Date | 2015-10-21 |
| Last Update Date | 2026-07-29 |