| NPI | 1225267891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS016305) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: PA OS016305) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT013274) | |
| Enumeration Date | 2009-07-04 |
| Last Update Date | 2017-11-22 |