| NPI | 1841532231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081H0002X (Licence: NY 288063) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 288063) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-23 |
| Last Update Date | 2021-01-14 |