| NPI | 1407533797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 65068) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT230037) |
| Enumeration Date | 2023-06-29 |
| Last Update Date | 2025-04-26 |