| NPI | 1477176303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0096610) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D96610) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT220667) | |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2023-06-22 |