| NPI | 1871163279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MA 3015665) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT224205) |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2024-06-02 |