| NPI | 1932144474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101241505) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 236865) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2025-03-03 |