| NPI | 1932737855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME168199) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA11830300) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2024-07-07 |