| NPI | 1982151585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PR 21430) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 308811-01) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 32438) | |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2026-02-13 |