| NPI | 1215480348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT217745) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP449533) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2022-06-27 |