| NPI | 1053774513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: PA MD475806) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.068925) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2022-06-30 |