| NPI | 1306074026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA MD455200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 15720) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2024-10-03 |