| NPI | 1750869186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD474677) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: DC MTL004835) |
| 207R00000X Internal Medicine (Licence: PA MT217142) | |
| Enumeration Date | 2018-07-28 |
| Last Update Date | 2021-07-09 |