| NPI | 1821473653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS021304) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 34.013406) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD 11018306A) | |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2021-10-04 |