| NPI | 1285150755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T9233) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.138915) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT212698) | |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2023-03-13 |