| NPI | 1124451018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD470821) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT214302) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA 1124451018) | |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2022-07-21 |