| NPI | 1073830105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A126906) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT196918) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT196918) | |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2014-08-08 |