| NPI | 1780098566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN DO3606) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MB10162400) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2018-11-20 |