| NPI | 1083596530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT233842) |
| Additional Taxonomies | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: PA MT233842) |
| Enumeration Date | 2025-07-24 |
| Last Update Date | 2025-07-25 |