| NPI | 1205357688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD478957) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL TRN25632) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 53520) | |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2023-05-31 |