| NPI | 1902184971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine Critical Care Medicine (Licence: NY 276598) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 004110) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2024-06-06 |