| NPI | 1659802445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT235988) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2020-02080) |
| 207R00000X Internal Medicine (Licence: NY 298956) | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2026-06-19 |