| NPI | 1447633730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 61128) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD475650) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT209843) | |
| Enumeration Date | 2015-07-04 |
| Last Update Date | 2022-04-01 |