| NPI | 1790164952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 167262) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA D7362369) |
| 207R00000X Internal Medicine (Licence: NY 286144) | |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2022-05-27 |