| NPI | 1578858494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0200X Internal Medicine Critical Care Medicine (Licence: SC 84945) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 84945) |
| 207R00000X Internal Medicine (Licence: MI 4301102912) | |
| 207RP1001X Internal Medicine Pulmonary Disease (Licence: SC 84945) | |
| 208600000X Surgery (Licence: PA MT200504) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT200504) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2021-09-03 |