| NPI | 1962994384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 185971) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 71915) |
| 207R00000X Internal Medicine (Licence: NY 301132) | |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2023-06-03 |