| NPI | 1518703552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.257995) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT231312) |
| Enumeration Date | 2024-07-08 |
| Last Update Date | 2025-06-14 |