| NPI | 1669859187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD467459) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.144086) |
| 208D00000X General Practice (Licence: PA MD467459) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2023-12-11 |