| NPI | 1578880977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0075666) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT196922) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT196922) | |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2013-06-12 |