| NPI | 1124697958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT222514) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT222514) |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2021-06-26 |