| NPI | 1205286481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS019783) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS18795) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OS019783) | |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2023-11-06 |