| NPI | 1164148276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD490270) |
| Enumeration Date | 2022-10-19 |
| Last Update Date | 2025-06-20 |