| NPI | 1659800571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C1-0025039) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD470946) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT213237) | |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2025-06-04 |