| NPI | 1578057410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD481722) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DE C1-0024310) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2023-08-07 |