| NPI | 1730560160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: OH 35.134352) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT208132) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2021-12-27 |