| NPI | 1699261677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS020228) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT018337) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OS020228) | |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2021-05-20 |