| NPI | 1831751726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 320711) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 30202) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2023-04-06 |