| NPI | 1598054702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ME MD25950) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD463110) |
| 207R00000X Internal Medicine (Licence: MA 262324) | |
| 208000000X Pediatrics (Licence: PA MD463110) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2022-08-19 |