NPI | 1023351921 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD466541) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 17113) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2013-03-29 |
Last Update Date | 2020-03-20 |