| NPI | 1750572012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D83234) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 0434380) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT191689) | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2020-06-24 |