| NPI | 1356902308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT019502) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS021055) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2024-08-26 |