| NPI | 1568648335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 200801404) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA mt185702) |
| 207R00000X Internal Medicine (Licence: PA mt185702) | |
| Enumeration Date | 2008-01-11 |
| Last Update Date | 2020-09-23 |