| NPI | 1194840918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0904X (Licence: KS 04-36243) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT183322) |
| 2085N0904X (Licence: MO 2009006302) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10044814) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2025-03-17 |