| NPI | 1487919908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 88543) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.126308) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT200813) | |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2021-09-09 |