| NPI | 1861948069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD207828) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT212109) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2023-08-07 |