| NPI | 1366733008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD449578) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT199091) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT199091) | |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2014-08-07 |