| NPI | 1164717369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: PA MT200466) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT200466) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT200466) | |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2017-04-11 |