| NPI | 1104318039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 25794) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS021580) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2024-07-22 |