| NPI | 1790048254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RI0001X Internal Medicine, Clinical & Laboratory Immunology (Licence: NJ 25MA09684900) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2015-08-27 |