| NPI | 1275153710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102207759) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT019839) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT019839) | |
| Enumeration Date | 2020-04-24 |
| Last Update Date | 2023-07-17 |