| NPI | 1366970337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: AZ 58630) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT214018) |
| 208D00000X General Practice (Licence: AZ 58630) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 2085R0001X (Licence: AZ R76666) | |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2026-03-12 |