| NPI | 1821200296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: TX P3019) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX P3019) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: PA MD434421) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT183437) | |
| Enumeration Date | 2007-05-05 |
| Last Update Date | 2023-09-06 |