| NPI | 1710470430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RI0200X Internal Medicine, Infectious Disease (Licence: ND 24235) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA12152100) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2026-08-05 |