| NPI | 1447994108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS024806) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT021562) |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2025-07-15 |