| NPI | 1164807152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD464580) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT209235) | |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2021-06-15 |