| NPI | 1518488246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: TX V1885) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 64878) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT213167) | |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2024-06-25 |