| NPI | 1629630173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS020937) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OT019584) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT019584) | |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2023-03-07 |