| NPI | 1477935906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 72873) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2018-0269) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT209065) | |
| Enumeration Date | 2015-06-20 |
| Last Update Date | 2022-12-02 |