| NPI | 1316434665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C1-0024963) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT216201) |
| 208000000X Pediatrics (Licence: DE C1-0024963) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-21 |
| Last Update Date | 2022-06-27 |