| NPI | 1780378703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT228791) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT228791) |
| Enumeration Date | 2023-06-05 |
| Last Update Date | 2026-07-08 |