| NPI | 1659942761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C1-0026990) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT223899) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT223899) | |
| Enumeration Date | 2021-07-09 |
| Last Update Date | 2024-06-11 |