| NPI | 1639864796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT233913) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD491145) |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2025-08-04 |