| NPI | 1902472277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 98611) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: NJ 25MA11947100) | |
| Enumeration Date | 2021-05-27 |
| Last Update Date | 2024-06-24 |