| NPI | 1790216166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: PA MD474448) |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine (Licence: MD D86181) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207R00000X Internal Medicine (Licence: MD D86181) | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2023-02-06 |