| NPI | 1467686212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD446389) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT194954) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT194954) | |
| Enumeration Date | 2009-05-08 |
| Last Update Date | 2014-06-22 |