| NPI | 1700209285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 297872) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 698866) |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2019-05-10 |