| NPI | 1093210817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD483811) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.146644) |
| 207R00000X Internal Medicine (Licence: LA 333546) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT229447) | |
| Enumeration Date | 2018-03-25 |
| Last Update Date | 2024-05-07 |