| NPI | 1548889561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS022579) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO4856) |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2023-05-07 |